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תינימ תוללעתה לש תוכלשה

Long-term Effects of Child Sexual Abuse
Paul E Mullen and Jillian Fleming
Abstract
Child sexual abuse is widely regarded as a cause of mental health problems in adult life.
This article examines the impact of child sexual abuse on social, sexual and interpersonal
functioning, and its potential role in mediating the more widely recognised impacts on mental
health. In discussing the relationship between child sexual abuse and adult psychopathology,
the authors evaluate a number of models, including the post-traumatic stress disorder model,
the traumatogenic model, and developmental and social models. They look at family risk factors
which predispose children from specific population groups to be at greater risk of abuse,
and conclude that the fundamental damage caused by child sexual abuse impacts on the child's
developing capacities for trust, intimacy, agency and sexuality.

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היצזימיטקיוור

The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism
Bessel A. van der Kolk, MD
introduction -
During the formative years of contemporary psychiatry much attention was paid to the continuing
role of past traumatic experiences on the current lives of people. Charcot, Janet, and Freud all
noted that fragmented memories of traumatic events dominated the mental life of many of their
patient and built their theories about the nature and treatment of psychopathology on this
recognition. Janet thought that traumatic memories of traumatic events persist as
unassimilated fixed ideas that act as foci for the development of alternate states of
consciousness, including dissociative phenomena, such as fugue states, amnesias, and chronic
states of helplessness and depression. Unbidden memories of the trauma may return as physical
sensations, horrific images or nightmares, behavioral reenactments, or a combination of these.
Janet showed how traumatized individuals become fixated on the trauma: difficulties in assimilating
subsequent experiences as well. It is "as if their personality development has stopped at a
certain point and cannot expand anymore by the addition or assimilation of new elements."
Freud independently came to similar conclusions. Initially, he thought all hysterical
symptoms were caused by childhood sexual "seduction" of which unconscious memories were
activated, when during adolescence, a person was exposed to situations reminiscent of the
original trauma. The trauma permanently disturbed the capacity to deal with other challenges,
and the victim who did not integrate the trauma was doomed to "repeat the repressed material
as a contemporary experience in instead or . . . remembering it as something belonging to
the past." In this article, I will show how the trauma is repeated on behavioral, emotional,
physiologic, and neuroendocrinologic levels, whose confluence explains the diversity of
repetition phenomena.

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As the Pendulum Swings: The Etiology of PTSD, Complex PTSD, and Revictimization
Anne M. Dietrich, M.A., CT
Abstract
During the 19th century, a picture was painted of trauma in which the focus was on pathologies
of the victims, including notions of inherited "moral degeneracy," with little cognizance of
the greater contextual factors, such as the traumatic events themselves, that contributed to
the symptom picture. The role of trauma in the etiology of posttraumatic symptoms was
incorporated into the DSM-III in 1980 and the PTSD category was initially viewed as an
improvement over earlier categorizations of trauma, as it acknowledged that some experiences
are so overwhelming that few people would escape unscathed. However, recent findings that
not all persons who have suffered traumatic events develop PTSD have led some writers to
discussion of a genetic component to PTSD. This article looks at this conclusion and the
role of individual and contextual factors in relation to PTSD, Complex PTSD, and revictimization.

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Multiplicity and Victimization: What part of 'No!' don't you understand?
Vs. What part of you doesn't understand 'No!'?"
Patricia D. McClendon, MSSW, CSW
Abstract
Although ego-state therapy (Watkins & Watkins, 1988 and Watkins, 1993) is essential in the
treatment of dissociative disorders and multiple personality disorder, it is seldom used with
the general client population. Since all people have multiplicity (Beahrs, 1982), I believe that
ego-state therapy is underutilized; it can be used to address people's multiplicity or different
levels of consciousness. Ego-state therapy is equivalent to doing family/group therapy within
the individual. State-dependent learning and memory are involved who we are in a given context;
we are a microcosm of our environment (Rivera, 1989). In cases of victimization, dissociative
disorders and multiple personality disorder are overlooked in the rush to punish the victimizer
and empower the victim. Drug and/or alcohol abuse is frequently involved in cases of victimization.
Many victims and victimizers are chemically dependent and are medicating the pain of their own
victimization that they experienced as children. Drugs and alcohol need to be recognized as
chemical dissociators (Beahrs, 1982; Braun, 1986; and Ross, 1989). The cycle of victimization
cannot be broken unless the victimizer's and the victim's multiplicity are therapeutically
acknowledged and confronted. Ross' (1989) general trauma model is the beginning of a paradigm
shift away from viewing psychiatric symptoms as psychopathological and biomedical: to, viewing
them as natural outcomes of trauma.

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המוארטב לפטמל תוצלמה

A Phenomenological Study of Vicarious Traumatisation Amongst Psychologists
and Professional Counsellors Working in the Field of Sexual Abuse/Assault
Lyndall G Steed and Robyn Downing
Abstract
In the past decade the field of traumatology has expanded to incorporate vicarious traumatisation
(VT); the impact on the therapist of exposure to traumatic client material. This study was designed
to investigate the VT effects experienced by therapists who work with sexual abuse/assault survivors.
Twelve psychologists and professional counsellors participated in semi-structured interviews which
explored their responses to hearing traumatic material, perceived effects of VT, alterations in
their cognitive schemata and their coping strategies. Findings indicated that therapists experience
a variety of severe negative effects which may have a pervasive impact on their functioning in
both personal and professional domains. However, positive sequelae were also noted, and thus
it is suggested that our conceptualisation of VT may be limited. The need to educate therapists
about the potential impact of VT and possible coping and preventive strategies is highlighted

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An Evaluation of Humour in Emergency Work
Carmen Moran and Margaret Massam
Abstract
Emergency work can be distressful, but in recent years there has also been a growing number
of publications which recognise the positive aspects experienced by emergency workers.
This paper identifies humour as a coping strategy which contributes to emergency workers'
adjustment to difficult, arduous and exhausting situations. We argue that humour enhances
communication, facilitates cognitive reframing and social support, and has possible physical
benefits. The authors believe an important delineation needs to be made between a healthy use
of humour and humour that is used to mask feelings in a way that will cause later distress.

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Trauma and the Therapist: The Experience of Therapists Working with the
Perpetrators of Sexual Abuse
Lyndall Steed & Jacquie Bicknell
Abstract
This study was designed to examine the existence of Secondary Traumatic Stress (STS) symptoms
in a sample of therapists working with sex offenders. A further aim was to examine the relationship
between STS and exposure to clients, operationalised as years of working with such clients
and percentage of caseload. An Australia-wide sample of 67 therapists completed the IES-R
(Weiss & Marmar, 1995) and the Compassion Fatigue Scale (CF, Figley, 1995). Findings confirmed
that STS symptoms are present in this population, and that a "U"-shaped relationship exists
between years of experience and avoidance such that therapists with the least and most
experience experience most avoidance. This study also provided evidence of the convergent
validity of the relatively new CF scale.

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תינימ תוללעתה ידרושב לופיט

Combining Voices: Supporting Paths of Healing in Adult Female and Male
Survivors of Sexual Abuse
Frederick Mathews, Ph.D., C. Psych.
Abstract
This is the first of two companion documents related to adult survivors of sexual abuse prepared
by the Canadian Foster Family Association (the second is entitled Combining Voices: Directory
of Services for Adult Survivors of Child Sexual Abuse). This paper introduces some of the
research findings, issues, concepts, and controversies pertaining to the support and care
of adult female and male survivors of sexual abuse. 1995, 65 p.

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Counseling for Change: Evolutionary Trends In Counseling Services
For Women Who Are Abused And For Their Children
Linda MacLeod
introduction
This monograph examines past and present trends in counselling services for abused women
and their children. Based on interviews with 60 counsellors from a variety of mainstream
and grassroots agencies across Canada, the report identifies common principles and strategies,
describes innovative counselling programs, and highlights emerging issues and dilemmas in
the field. Intended audience: frontline workers, researchers. 1990, 31 p.

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תינימ הפיקת יעגפנל יתצובק לופיט

From Victim to Survivor: A Group Treatment Model for Women Survivors
of Incest
Brenda J. Saxe
introduction
This manual outlines a group treatment program for women incest survivors developed by the
Family Service Centre of Ottawa-Carleton. The core section describes the steps involved in
facilitating each of twenty group sessions, including process guidelines, structured activities,
reflection and discussion, journal work, and handouts. Also included are theme modules to deal
with five topics found to be of particular concern to incest survivors: coping, conflict, anger,
intimacy, and self-injury.1993, 184 p.

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Peer Facilitated Support Groups For Abused Women (Self Help Canada Series)
Janet Freeman and Karen Larcombe
introduction
This fact sheet presents guidelines for establishing peer facilitated support groups
for women who are abused. It outlines the role of facilitators, types of support groups,
and group structures and philosophy. A brief list of suggested readings and resources is
provided. Intended audience: frontline workers and agencies serving women who are abused.

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Women's safety in recovery: group therapy for patients with a history of childhood sexual abuse.

Talbot NL, Houghtalen RP, Cyrulik S, Betz A, Barkun M, Duberstein PR, Wynne LC.

Department of Psychiatry, University of Rochester School of Medicine and Dentistry, NY 14642, USA. Psychiatr Serv. 1998 Feb;49(2):213-7.

The literature on group therapies for women with histories of childhood sexual abuse has focused on outpatient treatments. A model of group treatment for inpatients and partial hospital patients is described here. "Women's Safety in Recovery" is a first-stage trauma recovery group that promotes mastery of current life stressors and prevents regression through the use of psychoeducation about abuse effects, the practice of problem-solving skills, and supportive, topic-focused discussion. The group is structured in three one-week modules that patients can begin or leave at any time.

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Effects of Group Treatment for Women With a History of Childhood Sexual Abuse

Nancy L. Talbot, Ph.D., Rory P. Houghtalen, M.D., Paul R. Duberstein, Ph.D., Christopher Cox, Ph.D., Donna E. Giles, Ph.D. and Lyman C. Wynne, M.D., Ph.D.

Psychiatr Serv 50:686-692, May 1999

OBJECTIVE: Empirical support for the effectiveness of group therapies for women with a history of childhood sexual abuse is scant. This study examined the feasibility of conducting abuse-focused research and group treatment on a short-term unit and evaluated the effectiveness of the Women's Safety in Recovery group.

METHODS: Eighty-six women with a history of childhood sexual abuse participated in treatment as usual (N=38) or in the Women's Safety in Recovery group (N=48). The latter group met three times weekly for one hour, focusing on patients' current safety and self-care. Participants completed the Symptom ChecklistRevised at baseline, discharge, and six-month follow-up. Patients rated their experience in treatment at discharge and six-month follow-up, and therapists rated patients' treatment experiences at discharge. The feasibility of the treatment group was measured by enrollment rates, group attendance, and attrition. RESULTS: Eighty-two percent of eligible patients agreed to enroll in the study. Women's Safety in Recovery participants attended an average of ten group meetings. Seventy percent of enrollees completed discharge assessments, and of these, 82 percent completed the six-month follow-up. Compared with treatment-as-usual patients, Women's Safety in Recovery participants reported greater symptom improvement and reported that their childhood sexual abuse issues had been more thoroughly addressed. These differences were present at discharge and at six-month follow-up. Therapists also perceived that abuse issues of these participants had been more thoroughly addressed.

CONCLUSIONS: Women's Safety in Recovery participants reported significant reductions in distress compared with those receiving treatment as usual. The abuse-focused research program and the Women's Safety in Recovery group proved feasible, despite attrition.

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The role of mental health nursing in the prevention of child sexual abuse and the therapeutic care of survivors.
Long A, Smyth A.

School of Health Sciences, University of Ulster, Jordanstown, Newtownabbey, County Antrim, UK.
J Psychiatr Ment Health Nurs. 1998 Apr;5(2):129-36.

This paper is primarily designed to stimulate discussion and debate on the role of the mental health nurse dealing with survivors of sexual abuse. The authors contend that, in reality, all nurses should be prepared through education and training to treat the sufferers of emotional and spiritual pain, regardless of from where the hurting stems. The need for nurses to open their eyes and acknowledge the agony and distress caused to children as a result of abuse by adults is highlighted. So too is the necessity for nurses to enhance their own unique and specific practice. Nurses (and particularly mental health nurses) have a role in promoting a healthy generation of children--children who are looked after and protected by caregivers and not by caretakers. As the result of nurses advocating healthy caregiving and healthy relationships children may never need to suffer from inhumane and denigrating acts against their very beings. Nurses have no excuse for being unable to imagine child sexual abuse. Therefore they have no excuse for not being prepared to deal with the resulting, excruciating pain. It is both uncaring and inhumane for nurses not to be prepared to accept the sharing of such emotionally painful and disturbing experiences. Mental health nurses have a genuine role in offering therapeutic care to victims and survivors. This paper concludes by exploring and examining the nurse's role in counselling survivors of child sexual abuse.

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Living in danger: the impact of chronic traumatization and the traumatic context on posttraumatic stress disorder.

Kaysen D, Resick PA, Wise D.
University of Missouri-St Louis, USA.
Trauma Violence Abuse. 2003 Jul;4(3):247-64.

In this article on the effects of chronic traumatization, research is reviewed regarding the association between chronicity of traumatization and posttraumatic stress disorder (PTSD) symptomatology. The contribution of the broader traumatic context to PTSD symptomatology is also examined. This review focuses on three populations: combat veterans, child sexual abuse survivors, and survivors of domestic violence. The challenges of defining chronicity of a traumatic event and traumatic context are addressed. Finally, suggestions for future directions are provided.

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